Public healthcare expert recommends new COVID-19 vaccine strategy for India

Washington, April 21

As India experiences a new wave of COVID-19 pandemic, an Indian public healthcare expert has called for adopting a “build, buy and jab” strategy for mass vaccination to handle the crisis along with the enforcement of appropriate behaviours and continuous communication from doctors, political leaders and administration.

“We are witnessing an awful resurgence of the pandemic in India, where it was perceived, just a few months back, to be essentially over. Unfortunately, it lurked in the population and hit back with a vengeance when our guard was down,” Indian civil servant Dr Mrinalini Darswal, currently pursuing doctoral studies in public health with a focus on COVID-19 at Harvard University, told PTI.

It may be attributed in part to the pandemic fatigue in a population that relies on hard labour to earn a living and for whom waiting out the crisis over a prolonged period is not an option. However, the main reason seems to be the immune evading and highly infectious mutants, she said.

A 2002-batch Odisha-cadre IAS officer, Darswal served as Special Secretary, Health; Commissioner Food Safety; Drugs Controller, and Project Director for HIV/AIDS Control Programme for the Delhi government.

Darswal, who recently earned MSc Economics at University of Texas at Austin, argued that this virus is more elusive and unpredictable than the viruses that have been dealt with before, like flu and HIV. As such, vaccination is unlikely to be a successful strategy in isolation.

At the current rate of vaccination, it would take two years to cover 75 per cent of the Indian population, she said, adding that to get back to normal, there is a need to step up speed and coverage of the population manifold.

“As we aim to achieve the goal of full coverage, we need to move strategically,” Darswal said and called for the new potential strategy “build, buy and jab”.

“Build: We did exceptionally well in rolling out indigenous vaccines like Covaxin by utilising our expertise and getting priority allocation of Covishield from the Serum Institute of India (SII) -- the biggest vaccine manufacturer in the world. Given the sheer number of people we need to vaccinate, the quantum is falling short of the requirement,” she said.

There are at least two major concerns with this gap, Darswal said. First: the transmission of the virus is not suppressed enough for us to go back to normal. Second: the 'to and from' transmission of infection from non-vaccinated to vaccinated population gives a vast laboratory to the virus to learn to evade the immune response and develop into more virulent forms.

“That means we need to come up with modified vaccines frequently, and the goal of achieving transmission control through herd immunity will stretch indefinitely.

“Therefore, other indigenous vaccine developments, trials, and Emergency Use Authorisation (EUA) need to be fast-tracked. Government must keep a keen eye on raw material shortages faced by the SII in the production of the Novavax vaccine due to the export embargo on bags and filters imposed by the Biden administration under the Defence Production Act,” she said.

Production of other stuff like gloves, refrigerators, syringes among others also needs a full assessment, regulatory ease, and oversight for the long term.

Observing that meeting the entire requirement for vaccines within the home is possible but would take a long time, Darswal said utilising India's pharmaceutical manufacturing strength to get licenses for new manufacture and distribution of vaccines like the mRNA vaccines is something they can seriously consider.

And finally, India needs to replicate the Bhutan model in thousands of locations using a Primary Health Care (PHC) as the focal center. Using vaccines gifted by India, Bhutan vaccinated its entire population in two weeks.

Vaccine coverage must be provided at worksites like factories, big markets through market associations among others to ensure workers get vaccinated. Their safety will prevent mass migration as seen during the first lockdown, keep them safe, and add to the communities' overall immunity, she said.

“Even with a low attributable death rate, given that many people are getting infected in this new wave, the absolute count we may face may be staggering and spread panic among the people. Continuous communication from doctors, political leaders, and administrators is essential to calm the sentiments in this critical time,” said Darswal, who was a medical doctor before becoming an IAS officer.

“These measures need to be bolstered by solid regulation enforcing mandatory covid appropriate behaviours like universal mask-wearing, prohibition of activities where people can gather and form crowds, and compulsory maintenance of social distance when out. Only by being vigilant and responsible can we hope to minimise the damage of the current wave and make fast strides in beating the pandemic for good,” she said.

According to the Union Health Ministry data updated on Wednesday, the  single day rise in new coronavirus infections inched closer to 3 lakh, pushing India's total tally of COVID-19 cases to 1,56,16,130, while the death toll increased to 1,82,553 with a record 2,023 daily fatalities.

A total of 2,95,041 fresh infections were registered in a span of 24 hours, while the active cases crossed the 21-lakh mark, it said. PTI

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